The coronavirus curve bends toward reopening in hard-hit counties. Will it hold steady?

Matt Wynn / USA TODAY

Friday

Apr 24, 2020 at 1:03 PM

Across America, coronavirus infection rates are starting to decline in communities that weathered significant outbreaks – an indicator of when it may be OK to plan a return to normal.

Actions behind the improvement vary from place to place, USA TODAY found, from large cities that tracked down anyone who had contact with infected individuals to small towns that closed churches and ski resorts that were centers of infection.

These communities tended to follow the basic coronavirus playbook by closing schools and initiating social distancing measures – often earlier than required by their states. Many added more extreme measures: staggering shopping days by birthdates, testing sewage and closing county borders to travelers.

They view their success with cautious optimism.

In Milwaukee County, which added as few as 29 cases a day this week, down from 100 daily at the end of March, the emergency medical services director called the numbers encouraging. But, Ben Weston said, “it's a little too soon to say we're in the clear.”

In Chittenden County, Vermont, cases grew by leaps weeks ago, but the county added just a handful of infections this week as its testing capacity increased.

"Our death rate went up early and woke people up," said Tracy Dolan, the state's deputy health commissioner. "We're going to start slowly opening the spigot and will be watching for an increase in transmission."

USA TODAY’s analysis focused on 650 counties that consistently report daily case counts. Two-thirds experienced a high infection rate: at least 100 cases per 100,000 population. Of that group, 168 reported a significant slowdown last week – half as many new cases as the week before, or less.

From week to week, case numbers vary, and counties have widely different protocols for who gets tested, causing experts to warn officials and residents not to assume the worst is over.

“If you think about getting to a peak in new cases, that still means that there are more infectious people around you than any other time,” said Ellie Murray, assistant professor of epidemiology at Boston University. “So if you relax lockdowns, you undo all the work you’ve done to bring those numbers down.”

Cumberland County, Maine, is one of the places where positive signs haven’t panned out. From March 30 through April 6, the county added a total of 100 cases. The following week, it added 40.

The trend didn't hold: In the past week, the county reported 80 new cases.

Where glimmers of progress emerge, public health experts advised a renewed focus on vulnerable populations such as the homeless, the incarcerated and seniors in care facilities. The key, said Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins University, is to keep the social distance pressure on.

“I think it’s been remarkable to see people changing their lives so fundamentally and avert apocalyptic health care scenarios,” Sharfstein said. “We’ve proven we can do what’s necessary to fight the virus.”

Counties hope early action pays off

Communities with declines in new coronavirus cases credit a variety of efforts for their improvement.

In Onondaga County, New York, which surrounds Syracuse, cases were growing by dozens two weeks ago but slowed to single-digit increases. This week, they stand at 646 total in a community of nearly 500,000.

Ryan McMahon, the county’s executive, said that by 2:30 p.m. each day he gets new daily case figures from health experts before he addresses his community in a webstreamed event.

Onondaga County officials canceled a large St. Patrick’s Day parade and shut down schools in mid-March – earlier than the state mandate and before any outbreak in the county. It set up a testing site near vulnerable communities of color and advertised voluntary shelter-in-place rules before state guidelines were issued.

Residents were encouraged to spread out their essential shopping trips, using their birth years. Those born in odd years would shop Monday, Wednesday and Friday, and those born in even years would go Tuesday, Thursday and Saturday.

While many places in the USA continue to come up short on testing, Onondaga County has had excess capacity since March, McMahon said. Residents from as far away as the Bronx, Long Island and Buffalo, he said, have visited the county's drive-up facilities to get tested.

As Onondaga County's infection rates ebb, it is rolling out proactive testing for those without symptoms in nursing homes – both residents and workers.

“We know for our seniors with any underlying conditions, they have a nasty fight on their hands if they get the virus,” McMahon said. “We also want to find those asymptomatic employees before it becomes a problem.”

Contact tracing cited as a reason for success

Public health experts said reopening the economy will require contact tracing of new infections, in which teams of workers contact those potentially exposed, who can be tested and isolated.

Washtenaw County, Michigan – home to Ann Arbor – leaned on contact tracing to slow down an escalating problem. In the final week of March, the county saw its total number of confirmed cases leap from 82 to nearly 400. Over the past week, the county has added 98 cases.

The county is not easing up anytime soon, said Susan Ringler Cerniglia, a county public information officer.

"We are still doing contact tracing on every confirmed case,” she said.

Every person who tests positive is called and interviewed about whom they’ve talked to and where they’ve been. Based on those interviews, health officials identify others at risk. They reach out to those people and start the process again.

On any given day, the department has 12 staff members tracing contacts. They trained health educators and health safety inspectors to share the work.

“It is resource-intense,” Cerniglia said. “We have all of our nursing staff working on this, and not anything else.”

Planning to reopen the county next month, the department is thinking through how it can keep up with intensive contact tracing while resuming regular restaurant inspections and other routine work.

Opening things up will make tracing more complex: When most people shelter at home, the “web of contact,” Cerniglia said, is small.

Washtenaw County has taken creative approaches to isolation, such as offering hotel rooms to people with confirmed cases who are not able to isolate themselves at home. In nursing homes and homeless shelters, Cerniglia said, officials move quickly to treat and isolate those who test positive or had close contact with someone who did.

Organizations around the county worked together to get supplies into the hands of people who need them. Groups piggybacked on food distribution through schools to pass out cleaning supplies, safety masks and hand sanitizer.

"We are seeing some indications that all the hard work and all the sacrifices put into social distancing are starting to have an impact on the numbers,” Cerniglia said. “But all that said, we're fearful of jumping into normal levels of activities and seeing those cases jump right up."

Small communities tackle big coronavirus problems

For smaller communities, slowing the disease can be relatively simple. Tracking the path of infection can lead back to one location or event.

Bartow County, Georgia, saw an initial spike in cases after a “superspreader” event at the Church at Liberty Square on March 1. The church’s music minister was retiring. Worshippers traveled from across the state.

In the weeks after that event – which drew about 1,500 people – the tiny county saw its rate balloon to one of the highest in the state.

County officials issued a shelter-in-place order March 27, five days before the governor followed suit. Church services moved online.

For two straight weeks, the number of new cases slowed: 40 new cases last week, 30 this week.

“We were able to get that under control,” said Logan Boss, a county public information officer.

Other small communities have taken extreme measures to barricade themselves from the virus.

In Gunnison County, Colorado, home to the historic mining town and ski destination of Crested Butte, officials restricted all travel from outside the community’s borders April 3, threatening a $5,000 fine and jail time. They included people who own second homes there, partially out of concern that the 7,700-foot altitude could put sick patients at greater risk because they need more supplemental oxygen and ventilators.

“With spring break, we envisioned our community doubling in size, with 8,700 homes registered to out-of-town mailing addresses,” county spokesman Andrew Sandstrom said. “We’re a county with no ICU beds and 24 regular hospital beds.”

In March, Gunnison County prevented bars and restaurants from serving anyone 60 years or older – a twist on the standard practice of checking IDs for minors. It shut down all nonessential hospital visits, construction and golf courses.

The county partnered with a lab company that is testing fecal samples from five wastewater treatment facilities to track the spread of the virus and the impact of social distancing. In Massachusetts, the same startup – Biobot Analytics – found evidence of more infections than initially reported.

Active and new cases peaked March 20 in Gunnison County and have since slowed to a trickle, passing 100 total and three deaths. This week, the county eased restrictions, including allowing some construction to resume.

Matt Wynn is a data journalist on the USA TODAY investigations team, focusing primarily on public and consumer safety. Contact him at mwynn@usatoday.com or @mattwynn. Nick Penzenstadler is a reporter on the USA TODAY investigations team, focusing primarily on firearms and consumer financial protection. Contact him at npenz@usatoday.com or @npenzenstadler, or on Signal at (720) 507-5273. Mike Stucka is a data solutions editor on the USA TODAY investigative team.

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